1527 Ulcerative Colitis With Concomitant Serrated Polyposis Syndrome

INTRODUCTION: Ulcerative colitis (UC) is associated with increased risk of colon cancer. Current knowledge of UC with concomitant serrated polyposis syndrome (SPS) is limited and clinical guidelines regarding management is lacking. Sessile serrated adenomas and traditional serrated adenomas are precursors of at least 20% of sporadic colorectal carcinomas. Patients with SPS have higher risk of developing dysplastic lesions. We describe an interesting case of concurrent UC with SPS and a brief review of literature surrounding this association. CASE DESCRIPTION/METHODS: A 45-year old female with no significant past medical history presented to clinic for a 2-month history of change in bowel habits with bloating and occasional hematochezia. She denied a family history of colon cancer or inflammatory bowel diseases (IBD). Colonoscopy revealed three flat polyps measuring 2 mm, 7 mm and 8 mm in size at the cecal base, and two flat polyps each 11 mm in size in the ascending colon. All these polyps were removed and found to be of sessile serrated type on histopathology thereby meeting the WHO criteria for SPS. Patient was also found to have a 20 cm segment of inflammation in the rectum, biopsies showed diffuse chronic active proctitis with severe activity, meeting the criteria for ulcerative proctitis. Patient was started on mesalamine 1000 mg rectal suppository daily with plan for a repeat colonoscopy in 6 months to assess response. Laboratory analysis at time of colonoscopy showed C reactive protein <0.40 mg/dL, WBC count 6.12 × 10(9)/L and Hgb 12.5 g/dL. DISCUSSION: Frequency of occurrence of SPS among IBD patients seems to parallel that of general population. But the risk of colon cancer in this setting is unclear since IBD itself can give rise to colonic dysplasia. It has been suggested that a serrated pathway of carcinogenesis in inflammatory bowel disease is characterized by silencing of MGMT by gene promoter methylation, KRAS mutations, and potentially molecular alterations that are yet to be characterized and suspected to eventually lead to adenocarcinoma. Further studies are needed to define optimal management of these patients. This case highlights the complexity of managing this concurrent syndrome in patients with IBD.